In this interesting (and well-named) article, investigators tracked complication rates from hospital-based deliveries performed by experienced obstetricians in New York and Florida from 1992-2007. (Commentator’s note – Having the delivery as the unit of observation avoids some of the “denominator” problem in other specialties – for example, maybe good cardiologists keep their patients out of the hospital in the first place.) Several factors were found to predict lower complication rates: experience, with continued modest improvement across 3 decades; individual complication rate in the first year after residency, with lower-performers improving but never catching up with the average rate; and graduation from a “good” residency program. The “good” programs remained consistent over the decades studied. The authors point out that we don’t know if the “good” programs achieve these results by admitting higher-performing medical students, or by training them better, but the program effect was not changed when licensing examination scores were included in the model, suggesting that residency training is at least part of the equation. Effect sizes were around 1-3% on baseline complication rates of about 15%. –Laura Willett, MD
Asch DA, Nicholson S, Srinivas SK, Herrin J, Epstein AJ. How Do You Deliver a Good Obstetrician? Outcome-Based Evaluation of Medical Education. Acad Med. 2013 Nov 25.